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31 Jul 2024
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Complex Humeral Head Split Fracture Dislocation


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Clinical Details

Clinical and radiological findings:  A 64-year-old male pedestrian was struck by a pickup truck, resulting in a complex humeral head split fracture dislocation, along with chest and head trauma. Initial stabilization was required for the chest and head injuries. Radiological evaluation revealed a severe "nut cracker" fracture dislocation of the humeral head, with one fragment dislocated anteriorly and the other posteriorly. The fracture was classified as AO/OTA 11-C3.

Preoperative Plan

Planning remarks:  The preoperative plan involved an extended deltopectoral approach to achieve reduction of the humeral head split fracture dislocation. The subscapularis muscle was to be preserved, and fixation was planned using interfragmentary screws and dual plating techniques.

Surgical Discussion

Patient positioning:  Not Specified

Anatomical surgical approach:  Not Specified

Operative remarks: 

The anteriorly dislocated head fragment was reduced first, followed by the posterior fragment. Interfragmentary screws were used to achieve initial fixation of the fragments. Dual plates were then applied to provide fixation of the reconstructed humeral head. The subscapularis muscle remained intact throughout the procedure.

Postoperative protocol:   Originally posted on LInkedIn by Parag Shah, Chief consultant shoulder and upper limb surgeon, Ahmedabad, india

Follow up:   Not specified

Orthopaedic implants used:   Orthopaedic implants used: - Interfragmentary screws - Dual plates

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